Provider Demographics
NPI:1689640542
Name:WINER, ROBERT IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:IRA
Last Name:WINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 COLUMBINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-7943
Mailing Address - Country:US
Mailing Address - Phone:303-841-9863
Mailing Address - Fax:844-872-9528
Practice Address - Street 1:1510 COLUMBINE AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302
Practice Address - Country:US
Practice Address - Phone:303-586-1556
Practice Address - Fax:303-747-5726
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023070E2084N0400X, 2084P0800X
CO467482084P0800X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry